Provider Demographics
NPI:1306998208
Name:HOLCOMB, KINGSTON CHARLES (MSW LCSWC)
Entity type:Individual
Prefix:
First Name:KINGSTON
Middle Name:CHARLES
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:MSW LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 ROLLING ROAD
Mailing Address - Street 2:SUITE 23 ROCKDALE PROFESSIONAL BUILDING
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:410-521-4798
Mailing Address - Fax:410-521-4745
Practice Address - Street 1:3527 ROLLING ROAD
Practice Address - Street 2:SUITE 23
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21244
Practice Address - Country:US
Practice Address - Phone:410-521-4798
Practice Address - Fax:410-521-4745
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD062631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical